Data Cart

Your data extract

0 variables
0 samples
View Cart



DEMOGRAPHIC AND HEALTH SURVEYS - TANZANIA 1996 - WOMAN'S QUESTIONNAIRE

IDENTIFICATION

NAME OF HOUSEHOLD HEAD ______________________

CLUSTER NUMBER ___

HOUSEHOLD NUMBER ___

REGION ___________________ ___

DISTRICT __________________ ___

WARD __________________ ___

ENUMERATION AREA _______________ ___

LARGE CITY 1
SMALL CITY* 2
TOWN 3
COUNTRYSIDE 4

NAME AND LINE NUMBER OF WOMAN __________________ ___
NAME AND LINE NUMBER OF HUSBAND ___________________ ___

*SMALL CITIES ARE: MWANZA, ARUSHA, MOROGORO, DODOMA, MOSHI, TANGA, IRINGA, MBEYA, AND TABORA. ALL OTHER URBAN AREAS ARE TOWN.

INTERVIEWER VISITS

FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE ______________
INTERVIEWER'S NAME _______________
RESULT* ______________

RESULT

1 COMPLETED
2 NOT AT HOME
3 POSTPONED
4 REFUSED
5 PARTLY COMPLETED
6 INCAPACITATED
7 OTHER (SPECIFY) _________

NEXT VISIT:
DATE ______
TIME _____

FINAL VISIT
DAY ____
MONTH ____
YEAR 96
ID NO. ___
RESULT ____

TOTAL NUMBER OF VISITS __

TOTAL IN HOUSEHOLD __

TOTAL ELIG. WOMEN __

TOTAL ELIG. MEN __

LINE NO. OF RESP. TO HOUSEHOLD __

TRANSLATOR USED ___

1 NOT AT ALL
2 SOMETIME
3 ALL THE TIME

SUPERVISOR
NAME ________
DATE ________

FIELD EDITOR
NAME ________
DATE ________

OFFICE EDITOR

KEYED BY


SECTION 1. RESPONDENT'S BACKGROUND

101. RECORD THE TIME

MORNING/AM 1
AFTERNOON/PM 2
HOUR _______
MINUTES _______

102. First I would like to ask some questions about you and your household. For most of the time until you were 12 years old, did you live in Dar es Salaam city, another urban area or in a rural area?

DAR ES SALAAM 1
OTHER URBAN AREA 2
RURAL AREA/VILLAGE 3

103. How long have you been living continuously in (NAME OF CURRENT PLACE OF RESIDENCE)?

YEARS ___
ALWAYS 95 (GO TO 105)
VISITOR 96 (GO TO 105)

104. Just before you moved here, did you live in Dar es Salaam city, another urban area or in a rural area?

DAR ES SALAAM 1
OTHER URBAN AREA 2
RURAL AREA/VILLAGE 3

105. In what month and year were you born?

MONTH ___
DON'T KNOW MONTH 98
YEAR __
DOES NOT KNOW YEAR 98

106. How old were you at your last birthday?
COMPARE AND CORRECT 105 AND/OR 106 IF INCONSISTENT.

AGE IN COMPLETED YEARS ___

107. Can you read and write kiswahili easily, with difficulty, or not at all?

EASILY 1
WITH DIFFICULTY 2
NOT AT ALL 3 (GO TO 109)

108. How often do you read a newspaper?

EVERYDAY/ALMOST EVERYDAY 1
AT LEAST ONCE A WEEK 2
AT LEAST ONCE A MONTH 3
ONCE A MONTH 4
HARDLY EVER/ACTUALLY NEVER 5
DOES NOT KNOW 8

109. Have you ever attended school?

YES 1
NO 2 (GO TO 114)

110. What is the highest formal school you completed?

LESS THAN 1 YEAR 00
STANDARD 1 01
STANDARD 2 02
STANDARD 3 03
STANDARD 4 04
STANDARD 5 05
STANDARD 6 06
STANDARD 7 07
STANDARD 8 08
FORM 1 09
FORM 2 10
FORM 3 11
FORM 4 12
FORM 5 13
FORM 6 14
UNIVERSITY 15
OTHER (SPECIFY) ________________ 96

111. CHECK 106:

AGE 24 OR BELOW __ (GO TO 112)
AGE 25 OR ABOVE __ (GO TO 114)

112. Are you currently attending school?

YES 1 (GO TO 114)
NO 2

113. What was the main reason you stopped attending school?

GOT PREGNANT 01
GOT MARRIED 02
HAD TO CARE FOR YOUNGER CHILDREN 03
FAMILY NEEDED HELP ON FARM OR IN BUSINESS 04
COULD NOT PAY SCHOOL FEES 05
NEEDED TO EARN MONEY 06
GRADUATED/HAD ENOUGH SCHOOLING 07
BAD GRADES 08
DID NOT LIKE SCHOOL 09
SCHOOL NOT ACCESSIBLE/TOO FAR 10
NO SPACE/OPPORTUNITY TO CONTINUE 11
OTHER (SPECIFY) ______________ 96
DOES NOT KNOW 98

114. How often do you listen to the radio?

EVERYDAY/ALMOST EVERYDAY 1
AT LEAST ONCE A WEEK 2
AT LEAST ONCE A MONTH 3
ONCE A MONTH 4
HARDLY EVER/ACTUALLY NEVER 5
DOES NOT KNOW 8

115. Do you usually watch television at least once a week?

YES 1
NO 2

116. What is your religion?

MOSLEM 1
CATHOLIC 2
PROTESTANT 3
NONE 4
OTHER (SPECIFY)________ 6

117. To which tribe do you belong?
IF NOT TANZANIAN CITIZEN, WRITE NAME OF COUNTRY.

__________________ ___

118. CHECK Q.4 IN THE HOUSEHOLD QUESTIONNAIRE:

THE WOMAN INTERVIEWED IS NOT A USUAL RESIDENT __ (GO TO 119)
THE WOMAN INTERVIEWED IS A USUAL RESIDENT __ (GO TO 201)

119. Now I would like to ask about the place in which you usually live.
Do you usually live in Dar es Salaam city, another urban area or in a rural area?
IF CITY: In which city do you live?

(NAME OF CITY) ________________
DAR ES SALAAM, LARGE CITY 1
SMALL CITY 2
TOWN 3
COUNTRYSIDE 4

120. In which region is that located?
IF USUAL RESIDENCE IS OUTSIDE TANZANIA, WRITE COUNTRY.

REGION __________________ ___

121. Now I would like to ask about the household in which you usually live.
What is the main source of drinking water for members of your household?

PIPED WATER:
PIPED INTO HOUSE/YARD/PLOT 11 (GO TO 123)
PUBLIC/PRIVATE TAP 12
WELL WATER
WELL IN RESIDENCE/YARD/PLOT 21 (GO TO 123)
PUBLIC/PRIVATE WELL 22
SURFACE WATER:
SPRING 31
RIVER/STREAM 32
POND/LAKE 33
DAM 34
RAINWATER 41 (GO TO 123)
OTHER (SPECIFY) _______ 96

122. How long does it take to go there, get water, and come back?

MINUTES ___
ON PREMISES 996

123. What kind of toilet facility does your household have?
IF FLUSH TOILET, ASK IF IT IS SHARED WITH ANOTHER HOUSEHOLD.

FLUSH TOILET
OWN FLUSH TOILET 11
SHARED FLUSH TOILET 12
PIT TOILET/LATRINE
TRADITIONAL PIT TOILET 21
VENTILATED IMPROVED PIT LATRINE 22
NO FACILITY/BUSH/FIELD 31
OTHER (SPECIFY) ________ 96

124. Does your household have:

Electricity?
A radio?
A television?
A refrigerator?

ELECTRICITY
YES 1
NO 2
RADIO
YES 1
NO 2
TELEVISION
YES 1
NO 2
REFRIGERATOR
YES 1
NO 2

125. Can you describe the main material of the floor of your home?

NATURAL FLOOR
EARTH/SAND 11
RUDIMENTARY FLOOR
WOOD PLANKS 21
FINISHED FLOOR
PARQUET OR POLISHED WOOD 31
CERAMIC TILES 32
CEMENT 33
OTHER (SPECIFY) _____________ 96

126. Does any member of your household own:

A bicycle?
A motorcycle?
A car?

BICYCLE
YES 1
NO 2
MOTORCYCLE
YES 1
NO 2
CAR
YES 1
NO 2

127. Does your household always have enough food to eat, or do you have sometimes or frequently have not enough food to eat?

ALWAYS ENOUGH 1
SOMETIMES NOT ENOUGH 2
FREQUENTLY NOT ENOUGH 3
ALWAYS NOT ENOUGH 4
DOES NOT KNOW 8

SECTION 2. REPRODUCTION

201. Now I would like to ask about all the births you have had during your life. Have you ever given birth?

YES 1
NO 2 (GO TO 206)

202. Do you have any sons or daughters to whom you have given birth who are now living with you?

YES 1
NO 2 (GO TO 204)

203. How many sons live with you?
And how many daughters live with you?
IF NONE, RECORD '00'.

SONS AT HOME _____
DAUGHTERS AT HOME ______

204. Do you have any sons or daughters to whom you have given birth who are alive but do not live with you?

YES 1
NO 2 (GO TO 206)

205. How many sons are alive but do not live with you?
And how many daughters are alive but do not live with you?
IF NONE, RECORD '00'

SONS ELSEWHERE ____
DAUGHTERS ELSEWHERE ____

206. Have you ever given birth to a boy or a girl who was born alive but later died?
IF NO, PROBE: Any baby who cried or showed signs of life but survived only a few hours or days?

YES 1
NO 2 (GO TO 208)

207. How many boys have died?
And how many girls have died?
IF NONE, RECORD '00'.

BOYS DEAD ___
GIRLS DEAD ___

208. SUM ANSWERS TO 203, 205, AND 207, AND ENTER TOTAL.
IF NONE RECORD '00'.

TOTAL ___

209. CHECK 208:
Just to make sure that I have this right: you have had in total _____ births during your life. Is that correct?

YES __ (GO TO 210)
NO __ (PROBE AND CORRECT 201-208 AS NEEDED)

210. CHECK 208:

ONE OR MORE BIRTHS __ (GO TO 211)
NO BIRTHS __ (GO TO 226)

211. Now I would like to record the names of all your births, whether still alive or not, starting with the first one you had.
RECORD NAMES OF ALL THE BIRTHS IN 212. RECORD TWINS AND TRIPLETS ON SEPARATE LINES.

212. What name was given to your (first/next) baby?

(NAME) ___________

213. Were any of these births twins?

SING 1
MULT 2

214. Is (NAME) a boy or a girl?

BOY 1
GIRL 2

215. In what month and year was (NAME) born?
PROBE: What is his/her birthday?
OR: In what season was he/she born?

MONTH __________
YEAR __________

216. Is (NAME) still alive?

YES 1
NO 2 (GO TO 219)

217. IF ALIVE:
How old was (NAME) at his/her last birthday?
RECORD AGE IN COMPLETED YEARS.

AGE IN YEARS __

218. IF ALIVE:
Is (NAME) living with you?

YES 1 (GO TO NEXT BIRTH, OTHERWISE GO TO 220)
NO 2 (GO TO NEXT BIRTH; IF NO NEXT BIRTH, GO TO 220)

219. IF DEAD:
How old was (NAME) when he/she died?
IF '1 YR', PROBE: How many months old was (NAME)?
RECORD DAYS IF LESS THAN 1 MONTH; MONTHS IF LESS THAN TWO YEARS; OR YEARS.

DAYS 1 ____
MONTHS 2 ____
YEARS 3 ____

220. FROM YEAR OF BIRTH OF (NAME) SUBTRACT YEAR OF PREVIOUS BIRTH.
IS THE DIFFERENCE 4 OR MORE?

YES 1
NO 2 (GO TO NEXT BIRTH)

221. Were there any other live births between (NAME OF PREVIOUS BIRTH) and (NAME)?

YES 1
NO 2

222. FROM YEAR OF INTERVIEW SUBTRACT YEAR OF LAST BIRTH.
IS THE DIFFERENCE 4 YEARS OR MORE?

YES 1 (GO TO 223)
NO 2 (GO TO 224)

223. Have you had any live births since the birth of (NAME OF LAST BIRTH)?

YES 1
NO 2

224. COMPARE 208 WITH NUMBER OF BIRTHS IN HISTORY ABOVE AND MARK:

NUMBERS ARE DIFFERENT __ (PROBE AND RECONCILE)
NUMBERS ARE SAME __ CHECK:
FOR EACH BIRTH: YEAR OF BIRTH IS RECORDED. __
FOR EACH LIVING CHILD: CURRENT AGE IS RECORDED. __
FOR EACH DEAD CHILD: AGE AT DEATH IS RECORDED. __
FOR AGE AT DEATH 12 MONTHS OR 1 YR.: PROBE TO DETERMINE EXACT NUMBER OF MONTHS. __

225. CHECK 215 AND ENTER THE NUMBER OF BIRTHS SINCE JANUARY 1991.
IF NONE, RECORD '0'. __

226. Are you pregnant now?

YES 1
NO 2 (GO TO 229)
UNSURE 8 (GO TO 229)

227. How many months pregnant are you?
RECORD NUMBER OF COMPLETED MONTHS.

MONTHS _______

228. At the time you became pregnant, did you want to become pregnant then, did you want to wait until later, or did you not want to have any more children at all?

THEN 1
LATER 2
NOT WANT MORE CHILDREN 3

229. When did your last menstrual period start?

(DATE, IF GIVEN) ______________
DAYS AGO 1 __
WEEKS AGO 2 ___
MONTHS AGO 3 ___
YEARS AGO 4 ___
IN MENOPAUSE 994
BEFORE LAST BIRTH 995
NEVER MENSTRUATED 996

230. Between the first day of a woman's period and the first day of her next period, are there certain times when she has a greater chance of becoming pregnant than other times?

YES 1
NO 2 (GO TO 301)
DON'T KNOW 3 (GO TO 301)

231. During which times of the monthly cycle does a woman have the greatest chance of becoming pregnant?

DURING HER PERIOD 1
RIGHT AFTER HER PERIOD HAS ENDED 2
IN THE MIDDLE OF THE CYCLE 3
JUST BEFORE HER PERIOD BEGINS 4
OTHER (SPECIFY) _____ 6
DON'T KNOW 8

SECTION 3. CONTRACEPTION

Now I would like to talk about family planning - the various ways or methods that a couple can use to delay or avoid a pregnancy.
CIRCLE CODE 1 IN 301 FOR EACH METHOD MENTIONED SPONTANEOUSLY.
THEN PROCEED DOWN COLUMN 302, READING THE NAME AND DESCRIPTION OF EACH METHOD NOT MENTIONED SPONTANEOUSLY.
CIRCLE CODE 2 IF METHOD IS RECOGNIZED, AND CODE 3 IF NOT RECOGNIZED.
THEN, FOR EACH METHOD WITH CODE 1 OR 2 CIRCLED IN 301 OR 302, ASK 303.

301. Which ways or methods have you heard about?

METHOD 01 PILL Women can take a pill every day.
SPONTANEOUS YES 1
PROBED YES 2
NO 3 (GO TO NEXT METHOD)
METHOD 02 IUD Women can have a loop or coil placed inside them by a doctor or a nurse.
SPONTANEOUS YES 1
PROBED YES 2
NO 3 (GO TO NEXT METHOD)
METHOD 03 INJECTABLES Women can have an injection by a doctor or nurse which stops them from becoming pregnant for several months.
SPONTANEOUS YES 1
PROBED YES 2
NO 3 (GO TO NEXT METHOD)
METHOD 04 IMPLANTS Women can have several small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for several years.
SPONTANEOUS YES 1
PROBED YES 2
NO 3 (GO TO NEXT METHOD)
METHOD 05 DIAPHRAGM, FOAM, JELLY Women can place a sponge, suppository, diaphragm, jelly, or cream inside themselves before intercourse.
SPONTANEOUS YES 1
PROBED YES 2
NO 3 (GO TO NEXT METHOD)
METHOD 06 CONDOM, RUBBER, RAINCOAT, DUREX A man can wear a rubber bag in his penis during sex to prevent pregnancy. The rubber bag is also used to prevent passing diseases such as AIDS and for cleanliness.
SPONTANEOUS YES 1
PROBED YES 2
NO 3 (GO TO NEXT METHOD)
METHOD 07 FEMALE STERILIZATION Women can have an operation to avoid having any more children.
SPONTANEOUS YES 1
PROBED YES 2
NO 3 (GO TO NEXT METHOD)
METHOD 08 MALE STERILIZATION Men can have an operation to avoid having any more children.
SPONTANEOUS YES 1
PROBED YES 2
NO 3 (GO TO NEXT METHOD)
METHOD 09 CALENDAR/SAFE PERIOD Couples can have sexual intercourse only during the safe period of the monthly cycle that is the times during monthly cycle when women is least likely to get pregnant.
SPONTANEOUS YES 1
PROBED YES 2
NO 3 (GO TO NEXT METHOD)
METHOD 10 MUCUS METHOD A woman can observe daily the state of the mucus and avoid sexual intercourse at the time when the mucus is colorless and extremely elastic.
SPONTANEOUS YES 1
PROBED YES 2
NO 3 (GO TO NEXT METHOD)
METHOD 11 WITHDRAWAL Men can be careful and pull out before climax.
SPONTANEOUS YES 1
PROBED YES 2
NO 3 (GO TO NEXT METHOD)
METHOD 12 Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
SPONTANEOUS YES 1 (SPECIFY) ______________
NO 3 (GO TO NEXT METHOD)

302. Have you ever heard of (METHOD)?

METHOD 01 PILL Women can take a pill every day.
PROBED YES 2
NO 3 (GO TO NEXT METHOD)
METHOD 02 IUD Women can have a loop or coil placed inside them by a doctor or a nurse.
PROBED YES 2
NO 3 (GO TO NEXT METHOD)
METHOD 03 INJECTABLES Women can have an injection by a doctor or nurse which stops them from becoming pregnant for several months.
PROBED YES 2
NO 3 (GO TO NEXT METHOD)
METHOD 04 IMPLANTS Women can have several small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for several years.
PROBED YES 2
NO 3 (GO TO NEXT METHOD)
METHOD 05 DIAPHRAGM, FOAM, JELLY Women can place a sponge, suppository, diaphragm, jelly, or cream inside themselves before intercourse.
PROBED YES 2
NO 3 (GO TO NEXT METHOD)
METHOD 06 CONDOM, RUBBER, RAINCOAT, DUREX A man can wear a rubber bag in his penis during sex to prevent pregnancy. The rubber bag is also used to prevent passing diseases such as AIDS and for cleanliness.
PROBED YES 2
NO 3 (GO TO NEXT METHOD)
METHOD 07 FEMALE STERILIZATION Women can have an operation to avoid having any more children.
PROBED YES 2
NO 3 (GO TO NEXT METHOD)
METHOD 08 MALE STERILIZATION Men can have an operation to avoid having any more children.
PROBED YES 2
NO 3 (GO TO NEXT METHOD)
METHOD 09 CALENDAR/SAFE PERIOD Couples can have sexual intercourse only during the safe period of the monthly cycle that is the times during monthly cycle when women is least likely to get pregnant.
PROBED YES 2
NO 3 (GO TO NEXT METHOD)
METHOD 10 MUCUS METHOD A woman can observe daily the state of the mucus and avoid sexual intercourse at the time when the mucus is colorless and extremely elastic.
PROBED YES 2
NO 3 (GO TO NEXT METHOD)
METHOD 11 WITHDRAWAL Men can be careful and pull out before climax.
PROBED YES 2
NO 3 (GO TO NEXT METHOD)
METHOD 12 Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
NO 3

303. Have you ever used (METHOD)?

METHOD 01 PILL Women can take a pill every day.
YES 1
NO 2
METHOD 02 IUD Women can have a loop or coil placed inside them by a doctor or a nurse.
YES 1
NO 2
METHOD 03 INJECTIONS Women can have an injection by a doctor or nurse which stops them from becoming pregnant for several months.
YES 1
NO 2
METHOD 04 IMPLANTS Women can have several small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for several years.
YES 1
NO 2
METHOD 05 DIAPHRAGM, FOAM, JELLY Women can place a sponge, suppository, diaphragm, jelly, or cream inside themselves before intercourse.
YES 1
NO 2
METHOD 06 CONDOM, RUBBER, RAINCOAT, DUREX A man can wear a rubber bag in his penis during sex to prevent pregnancy. The rubber bag is also used to prevent passing diseases such as AIDS and for cleanliness.
YES 1
NO 2
METHOD 07 FEMALE STERILIZATION Women can have an operation to avoid having any more children.
Have you ever had an operation to avoid having any more children?
YES 1
NO 2
METHOD 08 MALE STERILIZATION Men can have an operation to avoid having any more children.
Have you ever had a partner who had an operation to avoid having children?
YES 1
NO 2
METHOD 09 CALENDAR/SAFE PERIOD Couples can have sexual intercourse only during the safe period of the monthly cycle that is the times during monthly cycle when women is least likely to get pregnant.
YES 1
NO 2
METHOD 10 MUCUS METHOD A woman can observe daily the state of the mucus and avoid sexual intercourse at the time when the mucus is colorless and extremely elastic.
YES 1
NO 2
METHOD 11 WITHDRAWAL Men can be careful and pull out before climax.
YES 1
NO 2
METHOD 12 Have you heard of any other ways or methods that women or men can use to avoid pregnancy?
YES 1
NO 2

304. CHECK 303:

NOT A SINGLE 'YES' (NEVER USED) __ (GO TO 305)
AT LEAST ONE 'YES' (EVER USED) __ (GO TO 307)

305. Have you ever used anything or tried in any way to delay or avoid getting pregnant?

YES 1
NO 2 (GO TO 330)

306. What have you used or done?
CORRECT 303 AND 304 (AND 302 IF NECESSARY).

307. Now I would like to ask you about the first time that you did something or used a method to avoid getting pregnant.
How many living children did you have at that time, if any?
IF NONE, RECORD '00'.

NUMBER OF CHILDREN _____

308. CHECK 303:

WOMAN NOT STERILIZED __ (GO TO 309)
WOMAN STERILIZED __ (GO TO 311A)

309. CHECK 226:

NOT PREGNANT OR UNSURE __ (GO TO 310)
PREGNANT __ (GO TO 331)

310. Are you currently doing something or using any method to delay or avoid getting pregnant?

YES 1
NO 2 (GO TO 330)

311. Which method are you using?
311A. CIRCLE '07' FOR FEMALE STERILIZATION.

PILL 01
IUD 02 (GO TO 324)
INJECTIONS 03 (GO TO 324)
IMPLANTS 04 (GO TO 324)
DIAPHRAGM/FOAM/JELLY 05 (GO TO 324)
CONDOM 06 (GO TO 324)
FEMALE STERILIZATION 07 (GO TO 319)
MALE STERILIZATION 08 (GO TO 319)
CALENDAR/SAFE PERIOD 09 (GO TO 323)
MUCUS METHOD 10 (GO TO 323)
WITHDRAWAL 11 (GO TO 324)
OTHER (SPECIFY) _________ 96 (GO TO 324)

312. May I see the package of pills you are now using?
RECORD NAME OF BRAND IF PACKAGE IS SEEN.

PACKAGE SEEN 1 (GO TO 314)
BRAND NAME ______________ ___
PACKAGE NOT SEEN 2

313. Do you know the brand name of the pills you are now using?
RECORD NAME OF BRAND.

BRAND NAME _____________ ___
DOES NOT KNOW 98

314. How much does one packet (cycle) of pills cost you?

COST ____
FREE 996
DOES NOT KNOW 998

315. When was the last time you took a pill?

DAYS AGO ___
MORE THAN ONE MONTH AGO 97

316. CHECK 315:

MORE THAN 2 DAYS AGO ___ (GO TO 317)
TWO DAYS AGO OR LESS ___ (GO TO 318)

317. Why aren't you taking the pills these days?

HUSBAND AWAY A
FORGOT B
HEALTH REASONS C
COST TOO MUCH D
NO NEED TO TAKE EVERYDAY E
RAN OUT F
CBD HAS NOT BROUGHT RESUPPLY G
MENSTRUATING H
OTHER (SPECIFY) __________________ X

318. Just about everyone forgets to take a pill sometime. What do you do when you forget to take a pill for two days in a row?

START TAKING AGAIN AS USUAL 1 (GO TO 324)
TAKE EXTRA/MISSED PILLS 2 (GO TO 324)
USE ANOTHER METHOD 3 (GO TO 324)
TAKE EXTRA PILL AND USE ANOTHER METHOD 4 (GO TO 324)
NEVER FORGOT 5 (GO TO 324)
OTHER (SPECIFY) __________________ 6 (GO TO 324)

319. Where did the sterilization take place?
IF SOURCE IS HOSPITAL, HEALTH CENTRE, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

(NAME OF PLACE) ________________
GOVERNMENT AND PARASTATAL
REGIONAL/CONSULTANT HOSPITAL 11
DISTRICT HOSPITAL 12
HEALTH CENTRE 13
DISPENSARY/PARASTATAL FACILITY 14
VILLAGE HEALTH POST/WORKER 15
MEDICAL PRIVATE SECTOR
RELIGIOUS ORG. FACILITY 21
PRIV. DOCTOR/CLINIC/HOSPITAL 22
OTHER (SPECIFY) _________________ 96
DOES NOT KNOW 98

320. Do you regret that (you/your husband) had the operation not to have any (more) children?

YES 1
NO 2 (GO TO 322)

321. Why do you regret the operation?

RESPONDENT WANTS ANOTHER CHILD 1
PARTNER WANTS ANOTHER CHILD 2
SIDE EFFECTS 3
CHILD DIED 4
OTHER (SPECIFY) ____________ 6

322. In what month and year was the sterilization performed?

MONTH ___ (GO TO 325)
YEAR ___ (GO TO 325)

323. You said that you have avoided having sexual intercourse on certain days of the month to avoid getting pregnant.
How do you determine which days of your monthly cycle not to have sexual relations?

BASED ON CALENDAR 1
BASED ON BODY TEMPERATURE 2
BASED ON CERVICAL MUCUS (BILLINGS METHOD) 3
BASED ON BODY TEMPERATURE AND CERVICAL MUCUS 4
NO SPECIFIC SYSTEM 5
OTHER (SPECIFY) ______________ 6

324. For how many months have you been using (METHOD) continuously?
IF LESS THAN 1 MONTH, RECORD '00'.

MONTHS __
8 YEARS OR LONGER 96

325. CHECK 314:
CIRCLE METHOD CODE:

PILL 01
IUD 02
INJECTIONS 03
IMPLANTS 04
DIAPHRAGM/FOAM/JELLY 05
CONDOM 06
FEMALE STERILIZATION 07 (GO TO 328A)
MALE STERILIZATION 08 (GO TO 328A)
CALENDAR/SAFE PERIOD 09 (GO TO 331)
MUCUS METHOD 10 (GO TO 331)
WITHDRAWAL 11 (GO TO 331)
OTHER (SPECIFY) _________ 96 (GO TO 331)

326. Where did you obtain (METHOD) the last time?
IF SOURCE IS HOSPITAL, HEALTH CENTRE, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

(NAME OF PLACE) ________________
GOVERNMENT AND PARASTATAL
REGIONAL/CONSULTANT HOSPITAL 11
DISTRICT HOSPITAL 12
HEALTH CENTRE 13
DISPENSARY/PARASTATAL FACILITY 14
VILLAGE HEALTH POST/WORKER 15
MEDICAL PRIVATE SECTOR
RELIGIOUS ORG. FACILITY 21
PRIV. DOCTOR/CLINIC/HOSPITAL 22
PHARMACY/MEDICAL STORE 23
CBD WORKER 24
OTHER PRIVATE SECTOR
SHOP/KIOSK 31
CHURCH 32
FRIENDS/RELATIVES/NEIGHBORS 33
HEALTH EDUCATOR/BAR GIRLS 34
OTHER (SPECIFY) _________________ 96
DOES NOT KNOW 98

327. Who obtained/helped to have the contraceptive?

HERSELF 1
HUSBAND 2
OTHER (SPECIFY) _______________ 6
DOES NOT KNOW 8

328. Do you know another place where you could have obtained (METHOD) the last time?
328A. At the time of the sterilization operation, did you know another place where you could have received the operation?

YES 1 (GO TO 333)
NO 2 (GO TO 333)

329. People select the place where they get family planning services for various reasons.
What was the main reason you went to (NAME OF PLACE IN Q.319 OR Q.326) instead of the other place you know about?

ACCESS-RELATED REASONS
CLOSER TO HOME 11 (GO TO 333)
CLOSER TO MARKET/WORK 12 (GO TO 333)
AVAILABILITY OF TRANSPORT 13 (GO TO 333)
SERVICE-RELATED REASONS
STAFF MORE COMPETENT/FRIENDLY 21 (GO TO 333)
CLEANER FACILITY 22 (GO TO 333)
OFFERS MORE PRIVACY 23 (GO TO 333)
SHORTER WAITING TIME 24 (GO TO 333)
LONGER HRS. OF OPERATION 25 (GO TO 333)
USE OTHER SERVICES AT THE FACILITY 26 (GO TO 333)
LOWER COST/CHEAPER 31 (GO TO 333)
WANTED ANONYMITY 41 (GO TO 333)
OTHER (SPECIFY) ______________ 96 (GO TO 333)
DON'T KNOW 98 (GO TO 333)

330. What is the main reason you are not using a method of contraception to avoid pregnancy?

NOT MARRIED 11
FERTILITY-RELATED REASONS
NOT HAVING SEX 21
INFREQUENT SEX 22
MENOPAUSAL/HYSTERECTOMY 23
SUBFECUND/INFECUND 24
POSTPARTUM/BREASTFEEDING 25
WANTS MORE CHILDREN 26
OPPOSITION TO USE
RESPONDENT OPPOSED 31
HUSBAND OPPOSED 32
OTHERS OPPOSED 33
RELIGIOUS PROHIBITION 34
LACK OF KNOWLEDGE
KNOWS NO METHOD 41
KNOWS NO SOURCE 42
METHOD-RELATED REASONS
HEALTH CONCERNS 51
FEAR OF SIDE EFFECTS 52
LACK OF ACCESS/TOO FAR 53
COST TOO MUCH 54
INCONVENIENT TO USE 55
INTERFERES WITH BODY'S NORMAL PROCESSES 56
OTHER (SPECIFY) _______________ 96
DOES NOT KNOW 98

331. Do you know of a place where you can obtain a method of family planning?

YES 1
NO 2 (GO TO 333)

332. Where is that?
IF SOURCE IS HOSPITAL, HEALTH CENTRE, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

(NAME OF PLACE) ________________
GOVERNMENT AND PARASTATAL
REGIONAL/CONSULTANT HOSPITAL 11
DISTRICT HOSPITAL 12
HEALTH CENTRE 13
DISPENSARY/PARASTATAL FACILITY 14
VILLAGE HEALTH POST/WORKER 15
MEDICAL PRIVATE SECTOR
RELIGIOUS ORG. FACILITY 21
PRIV. DOCTOR/CLINIC/HOSPITAL 22
PHARMACY/MEDICAL STORE 23
CBD WORKER 24
OTHER PRIVATE SECTOR
SHOP 31
CHURCH 32
FRIENDS/RELATIVES/NEIGHBORS 33
OTHER (SPECIFY) _________________ 96

333. Were you visited by a family planning program worker in the last 12 months?

YES 1
NO 2

334. Have you visited a health facility in the last 12 months for any reason?

YES 1
NO 2 (GO TO 335A)

335. Did anyone at the health facility speak to you about family planning methods?

YES 1
NO 2

335A. Have you seen or heard of the Green Star Logo (Symbol)?

YES 1
NO 2 (GO TO 336)
DOESN'T KNOW 8 (GO TO 336)

335B. What does the Green Star Logo mean to you?

FAMILY PLANNING RELATED 1
NOT FAMILY PLANNING RELATED 2
DOESN'T KNOW 8

335C. How did you learn about the Green Star?
CIRCLE ALL MENTIONED.

BILLBOARDS A
BUS B
POSTERS C
LEAFLETS D
RADIO E
CLINIC SIGN F
SERVICE PROVIDER G
OTHER (SPECIFY) _____________ X

336. Some women think that breastfeeding can affect their chance of becoming pregnant. Do you think a woman's chance of becoming pregnant is increased, decreased, or not affected by breastfeeding?

INCREASED 1 (GO TO 401)
DECREASED 2
NOT AFFECTED 3 (GO TO 401)
DEPENDS 4
DOES NOT KNOW 8 (GO TO 401)

337. CHECK 210:

ONE OR MORE BIRTHS __ (GO TO 338)
NO BIRTHS __ (GO TO 401)

338. Have you ever relied on breastfeeding as a method of avoiding pregnancy?

YES 1
NO 2 (GO TO 401)

339. CHECK 226 AND 308:

NOT PREGNANT OR UNSURE AND NOT STERILIZED __ (GO TO 340)
EITHER PREGNANT OR STERILIZED __ (GO TO 401)

340. Are you currently relying on breastfeeding to avoid getting pregnant?

YES 1
NO 2

SECTION 4A. PREGNANCY AND BREASTFEEDING

401. CHECK 225:

ONE OR MORE LIVE BIRTHS SINCE JAN.1991 __ (GO TO 402)
NO LIVE BIRTHS SINCE JAN.1991 __ (GO TO 465)

402. ENTER THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH SINCE JANUARY 1991 IN THE TABLE. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH.
(IF THERE ARE MORE THAN 2 BIRTHS, USE ADDITIONAL FORMS).

Now I would like to ask you some more questions about the health of children you had in the past five years. We will talk about one child at a time.

403. LINE NUMBER FROM Q212

LINE NUMBER _____

404. FROM Q212 AND Q216

NAME _______
ALIVE __ (GO TO 405)
DEAD __ (GO TO 405)

405. At the time you became pregnant with (NAME), did you want to become pregnant then, did you want to wait until later or did you want no more children at all?

THEN 1 (GO TO 407)
LATER 2
NO MORE 3 (GO TO 407)

406. How much longer would you like to have waited?

MONTHS 1 __
YEARS 2 __
DON'T KNOW 998

407. When you were pregnant with (NAME), did you see anyone for antenatal care for this pregnancy?
IF YES: Whom did you see? Anyone else?
PROBE FOR THE TYPE OF PERSON AND RECORD ALL PERSONS SEEN.

HEALTH PROFESSIONAL
DOCTOR/MEDICAL ASST A
RURAL MEDICAL AIDE B
NURSE/MIDWIFE C
MCH AIDE D
OTHER PERSON:
VILLAGE HEALTH WORKER E
TRAINED BIRTH ATTENDANT F
TRADITIONAL BIRTH ATTENDANT G
OTHER (SPECIFY) ________ X
NO ONE Y (GO TO 410)

408. How many months pregnant were you when you first received antenatal care?

MONTHS _____
DON'T KNOW 98

409. How many times did you receive antenatal care during this pregnancy?

NO. OF TIMES _____
DON'T KNOW 98

410. When you were pregnant with (NAME) were you given an injection in the arm to prevent the baby from getting tetanus, that is, convulsions after birth?

YES 1
NO 2 (GO TO 412)
DON'T KNOW 8 (GO TO 412)

411. During this pregnancy, how many times did you get this injection?

TIMES __
DON'T KNOW 8

412. Where did you give birth to (NAME)?

HOME:
YOUR HOME 11
OTHER HOME 12
GOVERNMENT AND PARASTATAL
HOSPITAL 21
HEALTH CENTRE 22
DISPENSARY 23
PARASTATAL HOSP/CLINIC 24
OTHER PUBLIC (SPECIFY) ________________ 26
PRIVATE SECTOR
RELIGIOUS ORG HOSP/CLIN 31
PRIVATE HOSPITAL/CLINIC 32
OTHER PRIVATE MEDICAL (SPECIFY) __________ 36
OTHER (SPECIFY) ________ 96

412A. CHECK 412 (11 OR 12): DELIVERED AT HOME

DELIVERED AT HOME ___ (GO TO 412B)
NOT DELIVERED AT HOME ___ (GO TO 413)

412B. Why did you deliver (NAME) at home?

PREFERRED AT HOME 1
TOO EXPENSIVE AT OUTSIDE 2
SERVICE NOT AVAILABLE 3
DOES NOT KNOW WHERE TO GO 4
COULD NOT REACH CLINIC ON TIME 5
OTHER REASON (SPECIFY) ________________ 6

413. Who assisted with the delivery of (NAME)? Anyone else?
PROBE FOR THE TYPE OF PERSON AND RECORD ALL PERSONS ASSISTING.

HEALTH PROFESSIONAL
DOCTOR/MEDICAL ASST A
RURAL MEDICAL AIDE B
NURSE/MIDWIFE C
MCH AIDE D
OTHER PERSON:
VILLAGE HEALTH WORKER E
TRAINED BIRTH ATTENDANT F
TRADITIONAL BIRTH ATTENDANT G
NEIGHBORS/RELATIVES H
OTHER (SPECIFY) ________ X
NO ONE Y

414. Around the time of the birth of (NAME), did you have any of the following problems:

Long labor, that is, did your regular contractions last more than 12 hours?
Excessive bleeding that was so much that you feared it was life threatening?
A high fever with bad smelling vaginal discharge?
Convulsions not caused by fever?

LABOR MORE THAN 12 HOURS
YES 1
NO 2
EXCESSIVE BLEEDING
YES 1
NO 2
FEVER/BAD SMELLING VAG. DISCHARGE
YES 1
NO 2
CONVULSIONS
YES 1
NO 2

414A. CHECK 412 (11 OR 12): DELIVERED AT HOME

NOT DELIVERED AT HOME ___ (GO TO 415)
DELIVERED AT HOME ___ (GO TO 416)

415. Was (NAME) delivered by caesarian section?

YES 1
NO 2

416. When (NAME) was born, was he/she:

very large,
larger than average,
average,
smaller than average,
or very small?

VERY LARGE 1
LARGER THAN AVERAGE 2
AVERAGE 3
SMALLER THAN AVERAGE 4
VERY SMALL 5
DON'T KNOW 8

417A. Was (NAME) weighed at birth?

YES 1
NO 2 (GO TO 418A)

417B. How much did (NAME) weigh?
RECORD WEIGHT FROM HEALTH CARD, IF AVAILABLE.

GRAMS FROM CARD 1 ____
GRAMS FROM RECALL 2 ____
DON'T KNOW 99998

418A. Did you see anyone for postpartum care within six weeks after delivery of (NAME)?

YES 1
NO 2 (GO TO 419)

418B. Who provided the postnatal care? Anyone else?
PROBE FOR THE TYPE OF PERSON AND RECORD ALL PERSONS CONSULTED?

HEALTH PROFESSIONAL
DOCTOR/MEDICAL ASST A
RURAL MEDICAL AIDE B
NURSE/MIDWIFE C
MCH AIDE D
OTHER PERSON
VILLAGE HEALTH WORKER E
TRAINED BIRTH ATTENDANT F
TRADITIONAL BIRTH ATTENDANT G
NEIGHBORS/RELATIVES H
OTHER (SPECIFY) ________ X
NO ONE Y

419. Has your period returned since the birth of (NAME)?

YES 1 (GO TO 421)
NO 2 (GO TO 422)

420. Did your period return between the birth of (NAME) and your next pregnancy?

YES 1
NO 2 (GO TO 424)

421. For how many months after the birth of (NAME) did you not have a period?

MONTHS ______
DON'T KNOW 98

422. CHECK 226:
RESPONDENT PREGNANT?

NOT PREGNANT __ (GO TO 423)
PREGNANT OR UNSURE __ (GO TO 424)

423. Have you resumed sexual relations since the birth of (NAME)?

YES 1
NO 2 (GO TO 425)

424. For how many months after the birth of (NAME) did you not have sexual relations?

MONTHS ___________
DON'T KNOW 98

425. Did you ever breastfeed (NAME)?

YES 1
NO 2 (GO TO 431)

426. How long after birth did you first put (NAME) to the breast?
IF LESS THAN 1 HOUR, RECORD '00'.
IF LESS THAN 24 HOURS, RECORD HOURS.
OTHERWISE, RECORD DAYS.

IMMEDIATELY 000
HOURS 1 ______
DAYS 2 ______

427. CHECK 404: CHILD ALIVE?

ALIVE __ (GO TO 428)
DEAD __ (GO TO 429)

428. Are you still breastfeeding (NAME)?

YES 1 (GO TO 432)
NO 2

429. For how many months did you breastfeed (NAME)?

MONTHS _________
DON'T KNOW 98

430. Why did you stop breastfeeding (NAME)?

MOTHER ILL/WEAK 01
CHILD ILL/WEAK 02
CHILD DIED 03
NIPPLE/BREAST PROBLEM 04
NOT ENOUGH MILK 05
MOTHER WORKING 06
CHILD REFUSED 07
WEANING AGE/AGE TO STOP 08
BECAME PREGNANT 09
STARTED USING CONTRACEPTION 10
OTHER (SPECIFY) _______ 96

431. CHECK 404: CHILD ALIVE?

ALIVE __ (GO TO 434)
DEAD __ (GO BACK TO 405 IN NEXT COLUMN OR, IF NO MORE BIRTHS, GO TO 440)

432. How many times did you breastfeed last night between sunset and sunrise?
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER.

NUMBER OF NIGHTTIME FEEDINGS ______

433. How many times did you breastfeed yesterday during the daylight hours?
IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER.

NUMBER OF DAYLIGHT FEEDINGS _________

434. Did (NAME) drink anything from a bottle with a nipple yesterday or last night?

YES 1
NO 2
DON'T KNOW 8

435. At any time yesterday or last night was (NAME) given any of the following:

Plain water?
Sugar water?
Juice?
Baby formula?
Cow's milk?
Any other liquids?
Ugali, uji or other food from rice, wheat or maize?
Any green vegetables?
Any yellow food like yams, mangoes, paw paws or carrots?
Eggs, fish or poultry?
Meat?
Any other solid or semi-solid food?

PLAIN WATER
YES 1
NO 2
DK 8
SUGAR WATER
YES 1
NO 2
DK 8
JUICE
YES 1
NO 2
DK 8
BABY FORMULA
YES 1
NO 2
DK 8
FRESH MILK
YES 1
NO 2
DK 8
OTHER LIQUIDS
YES 1
NO 2
DK 8
FOOD MADE FROM RICE/WHEAT/MAIZE
YES 1
NO 2
DK 8
GREEN VEGETABLES
YES 1
NO 2
DK 8
YELLOW FOOD - YAMS, MANGOES
YES 1
NO 2
DK 8
EGGS/FISH/POULTRY
YES 1
NO 2
DK 8
MEAT
YES 1
NO 2
DK 8
OTHER SOLID/SEMI-SOLID FOOD
YES 1
NO 2
DK 8

436. CHECK 435:
FOOD OR LIQUID GIVEN YESTERDAY?

'YES' TO ONE OR MORE __ (GO TO 437)
'NO/DK' TO ALL __ (GO TO 439)

437. (Aside from breastfeeding,) how many times did (NAME) eat yesterday, including both meals and snacks?
IF 7 OR MORE TIMES, RECORD '7'.

NUMBER OF TIMES ___
DON'T KNOW 8

439. GO BACK TO 405 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 440.

SECTION 4B. IMMUNIZATION AND HEALTH

440. ENTER LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH SINCE JANUARY 1991 IN THE TABLE. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 2 BIRTHS, USE ADDITIONAL QUESTIONNAIRES).

441. LINE NUMBER FROM Q212

LINE ____

442. FROM Q212 AND Q216

NAME ______
ALIVE __ (GO TO 443)
DEAD __ (GO TO 442 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 465)

443. Do you have a card where (NAME'S) vaccinations are written down?
IF YES: May I see it, please?

YES, SEEN 1 (GO TO 445)
YES, NOT SEEN 2 (GO TO 447)
NO CARD 3

444. Did you ever have a vaccination card for (NAME)?

YES 1 (GO TO 447)
NO 2 (GO TO 447)

445. (1) COPY VACCINATION DATES FOR EACH VACCINE FROM THE CARD.
(2) WRITE '44' IN 'DAY' COLUMN IF CARD SHOWS THAT A VACCINATION WAS GIVEN, BUT NO DATE IS RECORDED.

BCG
Polio 0 (at birth)
Polio 1
Polio 2
Polio 3
DPT 1
DPT 2
DPT 3
Measles

BCG
DAY ___
MO ___
YR ___
P0
DAY ___
MO ___
YR ___
P1
DAY ___
MO ___
YR ___
P2
DAY ___
MO ___
YR ___
P3
DAY ___
MO ___
YR ___
D1
DAY ___
MO ___
YR ___
D2
DAY ___
MO ___
YR ___
D3
DAY ___
MO ___
YR ___
MEA
DAY ___
MO ___
YR ___

446. Has (NAME) received any vaccinations that are not recorded on this card?
RECORD 'YES' ONLY IF RESPONDENT MENTIONS BCG, POLIO 0-3, DPT 1-3, AND/OR MEASLES VACCINATIONS.

YES 1 (PROBE FOR VACCINATIONS AND WRITE '66' IN THE CORRESPONDING DAY COLUMN IN 445) (GO TO 449)
NO 2 (GO TO 449)
DON'T KNOW 8 (GO TO 449)

447. Did (NAME) ever receive any vaccinations to prevent him/her from getting diseases?

YES 1
NO 2 (GO TO 449)
DON'T KNOW 8 (GO TO 449)

448. Please tell me if (NAME) received any of the following vaccinations:

448A. A BCG vaccination against tuberculosis, that is, an injection in the right shoulder that left a scar?

YES 1
NO 2
DON'T KNOW 8

448B. Polio vaccine, that is, drops in the mouth?

YES 1
NO 2 (GO TO 448E)
DON'T KNOW 8 (GO TO 448E)

448C. How many times?

NUMBER OF TIMES __

448D. When was the first polio vaccine given, just after birth or later?

JUST AFTER BIRTH 1
LATER 2

448E. DPT vaccination, that is, an injection usually given at the same time as polio drops?

YES 1
NO 2 (GO TO 448G)
DON'T KNOW 8 (GO TO 448G)

448F. How many times?

NUMBER OF TIMES __

448G. An injection against measles?

YES 1
NO 2
DON'T KNOW 8

449. Has (NAME) been ill with a fever at any time in the last 2 weeks?

YES 1
NO 2
DON'T KNOW 8

450. Has (NAME) been ill with a cough at any time in the last 2 weeks?

YES 1
NO 2 (GO TO 454)
DON'T KNOW 8 (GO TO 454)

451. When (NAME) had the illness with a cough, did he/she breathe faster than usual with short, fast breaths?

YES 1
NO 2
DON'T KNOW 8

452. Did you seek advice or treatment for the cough?

YES 1
NO 2 (GO TO 454)

453. Where did you seek advice or treatment? Anywhere else?
RECORD ALL MENTIONED.

GOVERNMENT AND PARASTATAL
HOSPITAL A
HEALTH CENTRE B
DISPENSARY C
PARASTATAL HOSP/CLINIC D
VILLAGE HEALTH POST/WORKER E
OTHER PUBLIC (SPECIFY) ___________________ F
MEDICAL PRIVATE SECTOR
RELIGIOUS ORG. HOSP/CLIN G
PRIVATE DOCTOR/HOSP/CLIN H
PHARMACY/MEDICAL STORE I
OTHER PRIVATE MEDICAL (SPECIFY) _______________ J
OTHER PRIVATE SECTOR
TRADITIONAL PRACTITIONER K
NEIGHBORS/RELATIVES L
OTHER (SPECIFY) ___________ X

454. Has (NAME) had diarrhea (three or more watery stools) in the last two weeks?

YES 1
NO 2 (GO TO 464)
DON'T KNOW 8 (GO TO 464)

455. Was there any blood in the stools?

YES 1
NO 2
DON'T KNOW 8

456. On the worst day of the diarrhea, how many bowel movements did (NAME) have?

NUMBER OF BOWEL MOVEMENTS __
DON'T KNOW 8

457. Was he/she given the same amount to drink as before the diarrhea, or more, or less?

SAME 1
MORE 2
LESS 3
DON'T KNOW 8

458. Was he/she given the same amount of food as before the diarrhea, or more, or less?

SAME 1
MORE 2
LESS 3
DON'T KNOW 8

460. Was anything (else) given to treat the diarrhea?

YES 1
NO 2 (GO TO 462)
DON'T KNOW 8 (GO TO 462)

461. What was given to treat the diarrhea? Anything else?
RECORD ALL TREATMENTS MENTIONED.

FLUID FROM ORS PACKET A
HOMEMADE SUGAR/SALT SOLN B
ANTIBIOTIC PILL OR SYRUP C
OTHER PILL OR SYRUP D
INJECTION E
DRIP F
HOME REMEDIES/HERBAL MEDICINES G
OTHER (SPECIFY) ____ X

462. Did you seek advice or treatment for the diarrhea?

YES 1
NO 2 (GO TO 464)

463. From whom or where did you seek advice or treatment? Anywhere else?
RECORD ALL MENTIONED.

GOVERNMENT AND PARASTATAL
HOSPITAL A
HEALTH CENTRE B
DISPENSARY C
PARASTATAL HOSP/CLINIC D
VILLAGE HEALTH POST/WORKER E
OTHER PUBLIC MEDCIAL (SPECIFY) ___________________ F
MEDICAL PRIVATE SECTOR
RELIGIOUS ORG. HOSP/CLIN G
PRIVATE DOCTOR/HOSP/CLIN H
PHARMACY/MEDICAL STORE I
OTHER PRIVATE MEDICAL (SPECIFY) _______________ J
OTHER PRIVATE SECTOR
TRADITIONAL PRACTITIONER K
NEIGHBORS/RELATIVES L
OTHER (SPECIFY) ___________ X

464. GO BACK TO 442 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 465.

465. When a child has diarrhea, should he/she be given less to drink than usual, about the same amount, or more than usual?

LESS TO DRINK 1
ABOUT SAME AMOUNT TO DRINK 2
MORE TO DRINK 3
DON'T KNOW 8

466. When a child has diarrhea, should he/she be given less to eat than usual, about the same amount, or more than usual?

LESS TO EAT 1
ABOUT SAME AMOUNT TO EAT 2
MORE TO EAT 3
DON'T KNOW 8

467. When a child is sick with diarrhea, what signs of illness would tell you that he or she should be taken to a health facility or health worker?
RECORD ALL MENTIONED.

REPEATED WATERY STOOLS A
ANY WATERY STOOLS B
REPEATED VOMITING C
ANY VOMITING D
BLOOD IN STOOLS E
FEVER F
MARKED THIRST G
NOT EATING/NOT DRINKING WELL H
GETTING SICKER/VERY SICK I
NOT GETTING BETTER J
OTHER (SPECIFY) ____________ X
DON'T KNOW Z

468. When a child is sick with a cough, what signs of illness would tell you that he or she should be taken to a health facility or health worker?
RECORD ALL MENTIONED.

FAST BREATHING A
DIFFICULT BREATHING B
NOISY BREATHING C
FEVER D
UNABLE TO DRINK E
NOT EATING/NOT DRINKING WELL F
GETTING SICKER/VERY SICK G
NOT GETTING BETTER H
OTHER (SPECIFY) __________ X
DON'T KNOW Z

469. CHECK 461, ALL COLUMNS:

NO CHILD RECEIVED ORS __ (GO TO 470)
QUESTION NOT ASKED __ (GO TO 470)
ANY CHILD RECEIVED ORS __ (GO TO 471)

470. Have you ever heard of a special product called ORS you can get for the treatment of diarrhea?

YES 1
NO 2

471. Have you fallen sick during the last 4 weeks?
SHOW PACKETS.

YES 1
NO 2 (GO TO 480)

472. What is the type of most recent illness?

FEVER 01
MALARIA 02
CHEST PROBLEM 03
JOINT BODY ACHE 04
STOMACH PROBLEMS 05
INJURIES 06
EYES PROBLEM 07
EARS PROBLEM 08
TEETH PROBLEM 09
GYNAECOLOGICAL 10
ANTENATAL 11
COUGH 12
OTHER (SPECIFY) _________________ 96

473. Where did you last go for treatment?

GOVERNMENT AND PARASTATAL
REGIONAL/CONSULTANT HOSPITAL 11
DISTRICT HOSPITAL 12
HEALTH CENTRE 13
DISPENSARY/PARASTATAL FACILITY 14
VILLAGE HEALTH POST/WORKER 15
MEDICAL PRIVATE SECTOR
RELIGIOUS ORG. FACILITY 21
PRIV. DOCTOR/CLINIC/HOSPITAL 22
PHARMACY/MEDICAL STORE 23
CBD WORKER 24
OTHER PRIVATE SECTOR
SHOP 31
CHURCH 32
FRIENDS/RELATIVES/NEIGHBORS 33
OTHER (SPECIFY) ___________ 96

474A. How long did it take to get there? (in minutes)

MINUTES ___

474B. How many kilometers did you travel?

KILOMETERS ___

475. Is there another health facility nearer your home than the one you went for treatment?

YES 1
NO 2 (GO TO 477)
DOES NOT KNOW 8 (GO TO 477)

476. What is the main reason you didn't go to the closer facility?
CIRCLE ONE ONLY.

WAS REFERRED HERE 01
YOU HAVE TO PAY THERE 02
NO DRUGS THERE 03
NO DOCTOR THERE 04
STAFF POOR HEALTH 05
EMPLOYER DOES NOT PAY THERE 06
OTHER FACILITY WOULD HAVE SENT HERE 07
OTHER FACILITY WOULD NOT HAVE SEEN 08
INCONVIENT HOURS OF OPERATION 09
SERVICES I NEEDED NOT AVAILABLE 10
WAITING TIME TOO LONG 11
OTHER (SPECIFY) ________________ 96
DOES NOT KNOW 98

477. How do you rate the service you received from the facility where you went?

POOR 1
FAIR 2
GOOD 3
EXCELLENT 4
DOES NOT KNOW 8

478. How much did treatment cost you?
i. Transport cost
ii. Clinic fee
iii. Cost of drugs
iv. Other expenses

NO COST/EMPLOYER PAID 00000 (GO TO 480)
TRANSPORT COST ___
CLINIC FEE ___
COST OF DRUGS ___
OTHER EXPENSES ___

479. Do you think the cost was too high, fair, or too low?

HIGH 1
FAIR 2
LOW 3
DOES NOT KNOW 8

480. Do you think that patients should be charged for each visit to raise funds for more drugs and other supplies for the facility?

YES 1
NO 2
DOES NOT KNOW 8

481. Do you ever go to a facility where you have to pay?

YES 1 (GO TO 483)
NO 2

482. Why not?

TOO EXPENSIVE 1 (GO TO 501)
TOO FAR 2 (GO TO 501)
OTHER (SPECIFY) _____________ 6 (GO TO 501)
DOES NOT KNOW 8 (GO TO 501)

483. How often do you visit a health facility where you have to pay?

RARELY 1
MOST OF THE TIME 2
ALL THE TIME 3
OTHER (SPECIFY) ________________ 6
DOES NOT KNOW 8

484. For what service did you go there last time?
CHOOSE ONE ONLY

CONSULTATION FOR ILLNESS 01
MATERNITY SERVICES 02
LABORATORY/X-RAY 03
DRUGS 04
FAMILY PLANNING 05
ANTE-NATAL CARE 06
IMMUNIZATION 07
OTHER (SPECIFY) _____________ 96
DOES NOT KNOW 98

SECTION 5. MARRIAGE

501. PRESENCE OF OTHERS AT THIS POINT.

CHILDREN UNDER 10
YES 1
NO 2
HUSBAND/PARTNER
YES 1
NO 2
OTHER MALES
YES 1
NO 2
OTHER FEMALES
YES 1
NO 2

502. Are you currently married or living with a man?

YES, CURRENTLY MARRIED 1 (GO TO 505)
YES, LIVING WITH A MAN 2 (GO TO 505)
NO, NOT IN UNION 3

503. Have you ever been married or lived with a man?

YES 1
NO 2 (GO TO 512)

504. What is your marital status now: are you widowed, divorced, or separated?

WIDOWED 1 (GO TO 509)
DIVORCED 2 (GO TO 509)
SEPARATED 3 (GO TO 509)

505. Is your husband/partner living with you now or is he staying elsewhere?

LIVES WITH HER 1
STAYING ELSEWHERE 2

506. Does your husband/partner have any other wives besides yourself?

YES 1
NO 2 (GO TO 509)
DOESN'T KNOW (GO TO 509)

507. How many other wives does he have?

NUMBER ___
DON'T KNOW 98 (GO TO 509)

508. Are you the first, second,... wife?

RANK ___

509. Have you been married or lived with a man only once or more than once?

ONCE 1
MORE THAN ONCE 2

510. In what month and year did you start living with your (first) husband/partner?

MONTH ___
DOES NOT KNOW MONTH 98
YEAR ___ (GO TO 512)
DOES NOT KNOW YEAR 98

511. How old were you when you started living with him?

AGE ___

512. CHECK 502:

MARRIED OR LIVING WITH A MAN ___ (GO TO 513)
NOT MARRIED AND NOT LIVING WITH A MAN ___ (GO TO 515)

513. Now I need to ask you some questions about sexual activity in order to gain a better understanding of some family planning issues.
When was the last time you had sexual intercourse with (your husband/the man you are living with)?

DAYS AGO 1 __
WEEKS AGO 2 __
MONTHS AGO 3 __
YEARS AGO 4 __
BEFORE LAST BIRTH 996

514. For that sexual intercourse, was a condom used?

YES 1
NO 2

515. Do you have a regular partner (apart from your husband)? I mean someone with whom you have been having sex for about a year or more?

YES 1
NO 2 (GO TO 517)

516. How many such regular partners do you have (aside from your husband)?

NUMBER ___

516A. When was the last time you had sexual intercourse with the regular partner (other than your husband)?

DAYS AGO 1 __
WEEKS AGO 2 __
MONTHS AGO 3 __
YEARS AGO 4 __
BEFORE LAST BIRTH 996

516B. For that sexual intercourse, was a condom used?

YES 1
NO 2

517. Have you had sexual intercourse with anyone (else) in the last 12 months? (I mean, with someone other than your husband or regular partner that you mentioned earlier?)

YES 1
NO 2 (GO TO 524)

518. With how many different people have you had sexual intercourse in the last 12 months (apart from your husband or regular partners)?

NUMBER ___

519. When was the last time you had sexual intercourse (apart from your husband/regular partner)?

DAYS AGO 1 __
WEEKS AGO 2 __
MONTHS AGO 3 __
YEARS AGO 4 __
BEFORE LAST BIRTH 996

520. For the last sexual intercourse, did you receive money, gifts or favours in return for sex?

YES 1
NO 2

521. Was this person someone you had met before or someone you met for the first time?

MET BEFORE 1
MET FOR FIRST TIME 2

522. Was a condom used for that sexual intercourse?

YES 1 (GO TO 524)
NO 2

523. What was the main reason that you did not use a condom that time?

__________________

524. CHECK 514, 516B OR 522:

CONDOMS USED WITH HUSBAND OR PARTNER(S) ___ (GO TO 524A)
DID NOT USE CONDOM WITH ANY ONE ___ (GO TO 524B)

524A. Last time you used a condom, where was that condom obtained?
IF SOURCE IS HOSPITAL, HEALTH CENTRE, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

(NAME OF PLACE) _________________________
GOVERNMENT AND PARASTATAL
REGIONAL/CONSULTANT HOSPITAL 11
DISTRICT HOSPITAL 12
HEALTH CENTRE 13
DISPENSARY/PARASTATAL FACILITY 14
VILLAGE HEALTH POST/WORKER 15
MEDICAL PRIVATE SECTOR
RELIGIOUS ORG. FACILITY 21
PRIV. DOCTOR/CLINIC/HOSPITAL 22
PHARMACY/MEDICAL STORE 23
CBD WORKER 24
OTHER PRIVATE SECTOR
SHOP 31
CHURCH 32
FRIENDS/RELATIVES/NEIGHBORS 33
OTHER (SPECIFY) ___________ 96
DOES NOT KNOW 98

524B. Have you heard of a condom called 'Salana'?

YES 1
NO 2

525. Now think back to the past. How old were you when you had sexual intercourse for the first time?

AGE ___
NEVER HAD SEX 95 (GO TO 601)
FIRST TIME WHEN MARRIED 96

526. In the last four weeks, how many times have you had sexual intercourse?

NUMBER OF TIMES ___
DOES NOT KNOW 98

SECTION 6. FERTILITY PREFERENCES

601. CHECK 311:

NEITHER STERILIZED __ (GO TO 602)
HE OR SHE STERILIZED __ (GO TO 612)

602. CHECK 226:
NOT PREGNANT OR UNSURE __
Now I have some questions about the future. Would you like to have (a/another) child or would you prefer not to have any (more) children?

PREGNANT __
Now I have some questions about the future. After the child you are expecting now, would you like to have another child or would you prefer not to have any more children?

HAVE (A/ANOTHER) CHILD 1
NO MORE/NONE 2 (GO TO 606)
SAYS SHE CAN'T GET PREGNANT 3 (GO TO 606)
UNDECIDED/DOES NOT KNOW 8 (GO TO 604)

603. CHECK 226:
NOT PREGNANT OR UNSURE __
How long would you like to wait from now before the birth of (a/another) child?

PREGNANT __
How long would you like to wait after the birth of the child you are expecting before the birth of another child?

MONTHS 1 ___
YEARS 2 ___
SOON/NOW 993 (GO TO 606)
SAYS SHE CAN'T GET PREGNANT 994 (GO TO 606)
AFTER MARRIAGE 995
OTHER (SPECIFY) _____ 996
DON'T KNOW 998

604. CHECK 226:

NOT PREGNANT OR UNSURE __ (GO TO 605)
PREGNANT __ (GO TO 607)

605. If you became pregnant in the next few weeks, would you be happy, unhapppy, or would it not matter very much?

HAPPY 1
UNHAPPY 2
WOULD NOT MATTER 3

606. CHECK 310: USING A METHOD?

NOT ASKED __ (GO TO 607)
NOT CURRENTLY USING __ (GO TO 607)
CURRENTLY USING __ (GO TO 612)

607. Do you think you will use a method to delay or avoid pregnancy within the next 12 months?

YES 1 (GO TO 609)
NO 2
DOES NOT KNOW 8

608. Do you think you will use a method at any time in the future?

YES 1
NO 2 (GO TO 610)
DOES NOT KNOW 8 (GO TO 610)

609. Which method would you prefer to use?

PILL 01 (GO TO 612)
IUD 02 (GO TO 612)
INJECTIONS 03 (GO TO 612)
IMPLANT 04 (GO TO 612)
DIAPHRAGM/FOAM/JELLY 05 (GO TO 612)
CONDOM 06 (GO TO 612)
FEMALE STERILIZATION 07 (GO TO 612)
MALE STERILIZATION 08 (GO TO 612)
CALENDAR/SAFE PERIOD 09 (GO TO 612)
MUCUS METHOD 10 (GO TO 612)
WITHDRAWAL 11 (GO TO 612)
OTHER (SPECIFY) _________ 96 (GO TO 612)
UNSURE 98 (GO TO 612)

610. What is the main reason you think you will never use a method?

NOT MARRIED 11
FERTILITY-RELATED REASONS
INFREQUENT/NO SEX 22 (GO TO 612)
MENOPAUSAL/HYSTERECTOMY 23 (GO TO 612)
SUBFECUND/INFECUND 24 (GO TO 612)
WANTS MORE CHILDREN 26 (GO TO 612)
OPPOSITION TO USE
RESPONDENT OPPOSED 31 (GO TO 612)
HUSBAND OPPOSED 32 (GO TO 612)
OTHERS OPPOSED 33 (GO TO 612)
RELIGIOUS PROHIBITION 34 (GO TO 612)
LACK OF KNOWLEDGE
KNOWS NO METHOD 41 (GO TO 612)
KNOWS NO SOURCE 42 (GO TO 612)
METHOD-RELATED REASONS
HEALTH CONCERNS 51 (GO TO 612)
FEAR OF SIDE EFFECTS 52 (GO TO 612)
LACK OF ACCESS/TOO FAR 53 (GO TO 612)
COST TOO MUCH 54 (GO TO 612)
INCONVENIENT TO USE 55 (GO TO 612)
INTERFERES WITH BODY'S NORMAL PROCESSES 56 (GO TO 612)
NO OTHER REASON 95 (GO TO 612)
OTHER (SPECIFY) _______________ 96 (GO TO 612)
DOES NOT KNOW 98 (GO TO 612)

611. Would you ever use a method if you were married?

YES 1
NO 2
DOES NOT KNOW 8

612. CHECK 216:

HAS LIVING CHILDREN __
If you could go back to the time you did not have any children and could choose exactly the number of children to have in your whole life, how many would that be?

NO LIVING CHILDREN __
If you could choose exactly the number of children to have in your whole life, how many would that be?

PROBE FOR A NUMERIC RESPONSE.

NUMBER ____
OTHER (SPECIFY) ____ 96 (GO TO 614)

613. How many of these children would you like to be boys, how many would you like to be girls and for how many would it not matter?

BOYS:
NUMBER ___
OTHER (SPECIFY) ____________ 96

GIRLS:
NUMBER ___
OTHER (SPECIFY) ____________ 96

EITHER:
NUMBER ___
OTHER (SPECIFY) ____________ 96

614. In general, do you approve or disapprove of couples using a method to avoid getting pregnant?

APPROVE 1
DISAPPROVE 2 (GO TO 617)
NO OPINION 3 (GO TO 617)

615. Have you ever recommended family planning to a friend, relative, or anyone else?

YES 1
NO 2

616. If you wanted to get information on family planning, who would you like to talk to the most?

CBD WORKER 01
CLINIC STAFF 02
TBA 03
HUSBAND/PARTNER 04
FRIEND 05
RELATIVE 06
RELIGIOUS LEADERS 07
OTHER (SPECIFY) _________________ 96

617. Is it acceptable or not acceptable to you for information on family planning to be provided:

On the radio?
On the television?

RADIO
ACCEPTABLE 1
NOT ACCEPTABLE 2
DK 8
TELEVISION
ACCEPTABLE 1
NOT ACCEPTABLE 2
DK 8

618. In the past six months have you heard about family planning:

On the radio?
On the television?
In a newspaper or magazine?
From a poster?
From billboards?
At community events/logo launches?
From live drama?
From a doctor or nurse?
From a community health worker?

RADIO
YES 1
NO 2
TELEVISION
YES 1
NO 2
NEWSPAPER OR MAGAZINE
YES 1
NO 2
POSTER
YES 1
NO 2
BILLBOARDS
YES 1
NO 2
COMMUNITY EVENT/LOGO LAUNCHES
YES 1
NO 2
LIVE DRAMA
YES 1
NO 2
DOCTOR OR NURSE
YES 1
NO 2
COMMUNITY HEALTH WORKER
YES 1
NO 2

619. In the past six months, what drama series have you listened to on the radio?
CIRCLE THE SERIES MENTIONED SPONTANEOUSLY. FOR SERIES NOT MENTIONED, ASK,
In the 6 months, have you listened to (NAME OF SERIES)?
Zinduka
Twende na Wakati
Ukweli Kuhusu Maisha
Other

ZINDUKA
YES SPONTANEOUS 1
YES PROBED 2
NO 3
TWENDE NA WAKATI
YES SPONTANEOUS 1
YES PROBED 2
NO 3
UKWELI KUHUSU MAISHA
YES SPONTANEOUS 1
YES PROBED 2
NO 3
OTHER
YES SPONTANEOUS 1
YES PROBED 2
NO 3

619A. CHECK 619:

LISTENED TO ZINDUKA ___ (GO TO 619B)
HAS NOT LISTENED TO ZINDUKA ___ (GO TO 619E)

619B. How often do you listen to Zinduka?

TWICE A WEEK 1
ONCE A WEEK 2
ONCE OR TWICE A MONTH 3
RARELY 4
DOES NOT KNOW 8

619C. As a result of listening to Zinduka, did you do anything or take any action related to family planning?

YES 1
NO 2 (GO TO 619E)
DOES NOT KNOW 8 (GO TO 619E)

619D. What did you do as a result of listening to Zinduka?
RECORD ALL MENTIONED.

TALKED TO PARTNER A
TALKED TO HEALTH WORKER B
TALKED TO SOMEONE ELSE C
VISITED A CLINIC FOR FAMILY PLANN D
BEGAN USING A MODERN METHOD E
CONTINUED USING A MODERN METHOD F
OTHER (SPECIFY) _______________ X
DOES NOT KNOW Z

619E. CHECK 619:

LISTENED TO TWENDE NA WAKATI ___ (GO TO 619F)
HAS NOT LISTENED TO TWENDE NA WAKATI ___ (GO TO 620)

619F. How often do you listen to Twende na Wakati?

TWICE A WEEK 1
ONCE A WEEK 2
ONCE OR TWICE A MONTH 3
RARELY 4
DOES NOT KNOW 8

620. In the last six months have you discussed family planning with your friends or relatives?

YES 1
NO 2 (GO TO 622)

621. With whom? Anyone else?
RECORD ALL MENTIONED.

HUSBAND/PARTNER A
MOTHER B
FATHER C
SISTER(S) D
BROTHER(S) E
DAUGHTER F
SONS G
MOTHER-IN-LAW H
FRIEND I
OTHER (SPECIFY) ___________ X

622. CHECK 502:

YES, CURRENTLY MARRIED __ (GO TO 623)
YES, LIVING WITH A MAN __ (GO TO 623)
NO, NOT IN UNION __ (GO TO 701)

623. Spouses/partners do not always agree on everything. Now I want to ask you about your husband's/partner's views on family planning.
Do you think that your husband/partner approves or disapproves of couples using a method to avoid pregnancy?

APPROVES 1
DISAPPROVES 2
DOES NOT KNOW 8

624. How often have you talked to your husband/partner about family planning in the past year?

NEVER 1
ONCE OR TWICE 2
MORE OFTEN 3

625. Have you and your husband/partner ever discussed the number of children you would like to have?

YES 1
NO 2

626. Who mainly decides how many children should you have?

HERSELF 1
HUSBAND 2
BOTH 3
OTHER (SPECIFY) ______________ 6
DOES NOT KNOW 8

627. Do you think your husband/partner wants the same number of children that you want, or does he want more or fewer than you want?

SAME NUMBER 1
MORE CHILDREN 2
FEWER CHILDREN 3
DOES NOT KNOW 8

SECTION 7. HUSBAND'S BACKGROUND AND WOMAN'S WORK

701. CHECK 502 AND 503:

CURRENTLY MARRIED/LIVING WITH A MAN __ (GO TO 702)
FORMERLY MARRIED/LIVED WITH A MAN __ (GO TO 703)
NEVER MARRIED AND NEVER IN UNION __ (GO TO 708)

702. How old was your husband/partner on his last birthday?

AGE _______

703. Did your (last) husband/partner ever attend school?

YES 1
NO 2 (GO TO 705)

704. What is the highest level of school he completed?

LESS THAN 1 YEAR 00
STANDARD 1 01
STANDARD 2 02
STANDARD 3 03
STANDARD 4 04
STANDARD 5 05
STANDARD 6 06
STANDARD 7 07
STANDARD 8 08
FORM 1 09
FORM 2 10
FORM 3 11
FORM 4 12
FORM 5 13
FORM 6 14
UNIVERSITY 15
OTHER (SPECIFY) ________________ 96

705. What is (was) your (last) husband/partner's occupation? That is, what kind of work does (did) he mainly do?

OCCUPATION_______________________ ___

706. CHECK 705:

WORKS (WORKED) IN AGRICULTURE __ (GO TO 707)
DOES (DID) NOT WORK IN AGRICULTURE __ (GO TO 708)

707. (Does/Did) your husband/partner work mainly on his own land or on family rent land, or borrow for share crop, government allocation, shifting cultivation land?

OWN LAND 1
FAMILY RENT 2
BORROW SHARE CROP 3
GOVERNMENT ALLOCATION 4
SHIFTING CULTIVATION 5

708. Aside from your own housework, are you currently working?

YES 1 (GO TO 710)
NO 2

709. As you know, some women take up jobs for which they are paid in cash or kind. Others sell things, have a small business or work on the family farm or in the family business.
Are you currently doing any of these things or any other work?

YES 1
NO 2 (GO TO 801)

710. Do you work for money for yourself, for someone else, or both?

HERSELF 1
SOMEONE ELSE 2 (GO TO 720)
BOTH 3

711. How many employees are working for you?

NUMBER OF EMPLOYEES ___
NONE 97

712. Do you work in agriculture, livestock, or poultry production?

YES 1
NO 2

713. Do you collect and sell wild products like honey, nuts, firewood, etc.?

YES 1
NO 2

714. Do you process food products for sale like pombe?

YES 1
NO 2

715. Do you engage in a craft or skilled work such as tailoring, making bricks, pottery, etc for money?

YES 1
NO 2

716. Do you do any other work for yourself such as own a shop or driving a taxi?
IF YES, specify?

(SPECIFY) _____________________
YES 1
NO 2

717. CHECK 712:

WORKS IN AGRICULTURE __ (GO TO 718)
DOES NOT WORK IN AGRICULTURE __ (GO TO 719)

718. Do you work mainly on your own land or on family rent land, or borrow for share crop, government allocation, shifting cultivation land?

OWN LAND 1
FAMILY RENT 2
BORROW SHARE CROP 3
GOVERNMENT ALLOCATION 4
SHIFTING CULTIVATION 5

719. CHECK 710:

WORKS FOR SOMEONE ELSE OR BOTH __ (GO TO 720)
WORKS FOR HERSELF __ (GO TO 723)

720. You told me that you (also) work for someone else.
Do you work for the government, for a private business, or a semi-government (parastatal) organization, or for family/friend?

GOVERNMENT 1
PRIVATE 2
SEMI-GOVERNMENT 3
FAMILY/FRIEND 4
DO NOT KNOW 8

721. Do you work in agriculture, I mean on a farm?

YES 1
NO 2

722. Do you yourself receive money from the following:

Money from friends/relatives?
Pension?
Rent?
Savings/Loans?

FRIENDS/RELATIVES
YES 1
NO 2
PENSION
YES 1
NO 2
RENT
YES 1
NO 2
SAVINGS/LOANS
YES 1
NO 2

723. CHECK 502:

YES, CURRENTLY MARRIED OR LIVING WITH A MAN __
Who mainly decides how the money you earn will be used: you, your husband/partner, you and your husband/partner jointly, or someone else?

NO, NOT IN UNION __
Who mainly decides how the money you earn will be used: you, someone else, or you and someone else jointly?

RESPONDENT DECIDES 1
HUSBAND/PARTNER DECIDES 2
JOINTLY WITH HUSBAND/PARTNER 3
SOMEONE ELSE DECIDES 4
JOINTLY WITH SOMEONE ELSE 5

SECTION 8. AIDS

801. CHECK 302(6):

HAS HEARD OF CONDOMS ___ (GO TO 802)
NEVER HEARD OF CONDOMS ___ (GO TO 809)

802. CHECK 303(06), 514, 516B, AND 522

HAS NEVER USED CONDOMS (ALL ARE 'NO') ___ (GO TO 803)
HAS USED CONDOMS (AT LEAST ONE 'YES') ___ (GO TO 804)

803. Have you ever seen a condom?

YES 1
NO 2

804. Do you know where you can get condoms?

YES 1
NO 2 (GO TO 806)

805. Where can you get condoms?
CIRCLE ALL MENTIONED.
PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

GOVERNMENT AND PARASTATAL
REGIONAL/CONSULTANT HOSPITAL A
DISTRICT HOSPITAL B
HEALTH CENTRE C
DISPENSARY/PARASTATAL FACILITY D
VILLAGE HEALTH POST/WORKER E
MEDICAL PRIVATE SECTOR
RELIGIOUS ORG. FACILITY F
PRIV. DOCTOR/CLINIC/HOSPITAL G
PHARMACY/MEDICAL STORE H
CBD WORKER I
OTHER PRIVATE SECTOR
SHOP J
CHURCH K
FRIENDS/RELATIVES/NEIGHBORS L
OTHER (SPECIFY) ___________ X
DOES NOT KNOW Z

806. How many times can a condom be used?

ONCE 1
MORE THAN ONCE 2
UNTIL IT BREAKS 3
OTHER (SPECIFY) _____________ 6
DOES NOT KNOW 8

808. In general, do you think that most women like men to use condoms, they don't like men to use condoms, or it does not matter?

LIKE MEN TO USE CONDOMS 1
DIDN'T LIKE MEN TO USE CONDOMS 2
DOES NOT MATTER 3
OTHER (SPECIFY) _____________ 6
DOES NOT KNOW 8

809. Have you heard about diseases that can be transmitted through sex?

YES 1
NO 2 (GO TO 822)

810. What diseases do you know?
(RECORD ALL DISEASES SHE MENTIONED)

SYPHILIS A
GONORRHOEA B
AIDS C
GENITAL WARTS/CONDYLOMATA D
OTHER (SPECIFY) _____________ X
DON'T KNOW Z

811. CHECK 525:

HAS HAD SEX ___ (GO TO 812)
HAS NEVER HAD SEX ___ (GO TO 822)

812. During the last 12 months, did you have any of these diseases (MENTIONED IN Q.810)?

YES 1
NO 2 (GO TO 822)
DON'T KNOW (GO TO 822)

813. Which of the diseases did you have?
CIRCLE ALL MENTIONED.

SYPHILIS A
GONORRHOEA B
AIDS C
GENITAL WARTS/CONDYLOMATA D
OTHER (SPECIFY) _____________ X
DON'T KNOW Z

817. When you had this (DISEASE FROM Q.813) did you seek advice or treatment?

ADVICE/TREATMENT 1
SELF TREATMENT 2 (GO TO 819)
DID NOT DO ANYTHING 3 (GO TO 819)

818. Where did you seek advice or treatment?
Any other place or person?
RECORD ALL MENTIONED.

GOVERNMENT AND PARASTATAL
REGIONAL/CONSULTANT HOSPITAL A
DISTRICT HOSPITAL B
HEALTH CENTRE C
DISPENSARY/PARASTATAL FACILITY D
VILLAGE HEALTH POST/WORKER E
MEDICAL PRIVATE SECTOR
RELIGIOUS ORG. FACILITY F
PRIV. DOCTOR/CLINIC/HOSPITAL G
PHARMACY/MEDICAL STORE H
CBD WORKER I
OTHER PRIVATE SECTOR
SHOP J
CHURCH K
FRIENDS/RELATIVES/NEIGHBORS L
OTHER (SPECIFY) ___________ X

818A. CHECK 502 AND 503

CURRENTLY MARRIED/LIVING WITH A MAN ___ (GO TO 819)
FORMERLY IN A UNION ___ (GO TO 819)
NEVER IN A UNION ___ (GO TO 822)

819. Did you tell your husband/partner that you had (DISEASE(S) FROM 813)?

YES 1
NO 2

820. When you had this (DISEASE(S) FROM 813) did you do something so as not to infect your partner?

YES 1
NO 2 (GO TO 822)
PARTNER ALREADY INFECTED 3 (GO TO 822)

821. What did you do?
CIRCLE ALL MENTIONED.

NO SEXUAL INTERCOURSE A
USED CONDOMS B
TOOK MEDICINES C
TOLD HIM TO GO FOR MEDICAL HELP D
OTHER (SPECIFY) ______________ X

822. CHECK 810:

DID NOT MENTION AIDS OR QUESTION NOT ASKED ___ (GO TO 823)
MENTIONED 'AIDS' ___ (GO TO 824)

823. Have you ever heard of an illness called AIDS?

YES 1
NO 2 (GO TO 901)

824. From which sources of information have you learned about AIDS?
Any other sources?
RECORD ALL MENTIONED.

RADIO A
TV B
NEWSPAPERS/MAGAZINES C
PAMPLETS/POSTERS D
HEALTH WORKERS E
MOSQUES/CHURCHES F
SCHOOLS/TEACHERS G
COMMUNITY MEETINGS H
FRIENDS/RELATIVES I
WORK PLACE J
OTHER (SPECIFY) ___________X

825. Is there anything a person can do to avoid getting AIDS or the virus that causes AIDS?

YES 1
NO 2 (GO TO 827)
DOES NOT KNOW 8 (GO TO 827)

826. What can a person do to avoid getting AIDS or the virus that causes AIDS?
Any other ways?
CIRCLE ALL MENTIONED.

DO NOT HAVE SEX AT ALL A
USE CONDOMS DURING SEX B
DON'T HAVE SEX WITH PROSTITUTES C
DO NOT HAVE SEX WITH HOMOSEXUALS D
DO NOT HAVE MANY SEX PARTNERS E
HAVE ONLY ONE SEX PARTNER F
AVOID BLOOD TRANSFUSIONS G
AVOID INJECTIONS H
DON'T HAVE CHILDREN I
AVOID KISSING J
AVOID MOSQUITO BITES K
SEEK PROTECTION FROM TRADITIONAL HEALER L
DO NOT DRINK TOO MUCH ALCOHOL M
OTHER (SPECIFY) ___________ X
DOES NOT KNOW Z

827. Do you think a person can protect themselves from getting AIDS by:

having a good diet?
staying with one faithful partner?
avoid stepping on the urine or stool of a person with AIDS?
using condoms?
avoiding touching a person who has AIDS?
not sharing eating utensils with a person with AIDS?
avoiding being bitten by mosquitos or other insects?
making sure any injection they have is done with a clean needle?

GOOD DIET
YES 1
NO 2
DK 8
STAY WITH ONE PARTNER
YES 1
NO 2
DK 8
AVOID URINE OR STOOL
YES 1
NO 2
DK 8
USE CONDOMS
YES 1
NO 2
DK 8
DON'T TOUCH PERSON
YES 1
NO 2
DK 8
DON'T SHARE UTENSILS
YES 1
NO 2
DK 8
AVOID INSECT BITES
YES 1
NO 2
DK 8
INJECTION WITH CLEAN NEEDLE
YES 1
NO 2
DK 8

828. Is it possible for a healthy-looking person to have the AIDS virus?

YES 1
NO 2
DOES NOT KNOW 8

829. Can AIDS be cured?

YES 1
NO 2
DOES NOT KNOW 8

830. Can AIDS be transmitted from mother to child?

YES 1
NO 2 (GO TO 831)
DOES NOT KNOW 8 (GO TO 831)

830A. How do you think that it can be transmitted?
CIRCLE ALL MENTIONED.

DURING PREGNANCY A
DURING DELIVERY B
THROUGH BREASTFEEDING C
OTHER (SPECIFY) ______________ X
DOES NOT KNOW Z

831. Does any member of your household have AIDS or has any member of your household died of AIDS?

YES 1 (GO TO 832)
NO 2
DOES NOT KNOW 8

831A. Do you personally know someone who has AIDS or has died of AIDS?

YES 1
NO 2
DOES NOT KNOW 8

832. Do you think your chances of getting AIDS are small, moderate, great, or no risk at all?

SMALL 1
MODERATE 2 (GO TO 834)
GREAT 3 (GO TO 834)
NO RISK AT ALL 4
DOES NOT KNOW 8 (GO TO 834A)
HAS AIDS 9 (GO TO 901)

833. Why do you think that you have (no risk/a small chance) of getting AIDS?
Any other reasons?
CIRCLE ALL MENTIONED.

NO SEXUAL INTERCOURSE A (GO TO 834A)
NO SEX WITH PROSTITUTES B (GO TO 834A)
SLEEP ONLY WITH SPOUSE/PARTNER C (GO TO 834A)
USE CONDOMS D (GO TO 834A)
NO INJECTIONS E (GO TO 834A)
NO BLOOD TRANSFUSIONS F (GO TO 834A)
OTHER (SPECIFY) ___________________X (GO TO 834A)
DOES NOT KNOW Z (GO TO 834A)

834. Why do you think that you have a (moderate/great) chance of getting AIDS?
Any other reasons?
CIRCLE ALL MENTIONED.

MULTIPLE SEX PARTNERS A
SEX WITH PROSTITUTES B
SPOUSE HAS MULTIPLE PARTNERS C
DO NOT USE CONDOMS D
HAD INJECTIONS E
HAD BLOOD TRANSFUSION F
OTHER (SPECIFY) ___________________X
DOES NOT KNOW Z

834A. CHECK 811:

HAS HAD SEX __ (GO TO 835)
HAS NEVER HAD SEX __ (GO TO 838)

835. Since you heard of AIDS, have you changed your sexual behavior to prevent getting AIDS?

YES 1
NO 2 (GO TO 837)
DOES NOT KNOW 8 (GO TO 837)

836. What did you do?
Anything else?
CIRCLE ALL MENTIONED.

ONE PARTNER A
STOPPED HAVING MANY SEX PARTNERS B
STOPPED SEX WITH PROSTITUTES C
STARTED USING CONDOMS D (GO TO 838)
USED CONDOMS MORE OFTEN E (GO TO 838)
ABSTINENCE (STOPPED HAVING SEX WITH ANYONE) F
OTHER (SPECIFY) __________________ X

837. Have you ever used a condom during sex to avoid getting or transmitting diseases, such as AIDS?

YES 1
NO 2

838. Have you ever been tested to see if you have the AIDS virus?

YES 1 (GO TO 841A)
NO 2
DOES NOT KNOW/NOT SURE 8

839. Would you like to be tested for the AIDS virus?

YES 1
NO 2
DOES NOT KNOW/NOT SURE 8

840. Do you know of a place where you could go to get an AIDS test?

YES 1
NO 2 (GO TO 842)
DOES NOT KNOW/NOT SURE 8 (GO TO 842)

841. Where could you go?
841A. Where did you go?

GOVERNMENT AND PARASTATAL
REGIONAL/CONSULTANT HOSPITAL A
DISTRICT HOSPITAL B
HEALTH CENTRE C
DISPENSARY/PARASTATAL FACILITY D
VILLAGE HEALTH POST/WORKER E
MEDICAL PRIVATE SECTOR
RELIGIOUS ORG. FACILITY F
PRIV. DOCTOR/CLINIC/HOSPITAL G
PHARMACY/MEDICAL STORE H
CBD WORKER I
OTHER PRIVATE SECTOR
SHOP J
CHURCH K
FRIENDS/RELATIVES/NEIGHBORS L
OTHER (SPECIFY) ___________ X
DOES NOT KNOW Z

842. What do you suggest is the most important thing the government should do for people who have AIDS?

PROVIDE MEDICAL TREATMENT 1
HELP RELATIVES PROVIDE CARE 2
ISOLATE/QUARANTINE/JAIL PEOPLE 3
NOT BE INVOLVED 4
OTHER (SPECIFY) ___________________ 6

843. If a member of your family is suffering from AIDS would you be willing to care for him or her at home?

YES 1
NO 2
DEPENDS 3
OTHER (SPECIFY) __________________ 6
NOT SURE/DO NOT KNOW 8

SECTION 9. MATERNAL MORTALITY

901. Now I would like to ask you some questions about your brothers and sisters, that is, all of the children born to your natural mother, including those who are living with you, those living elsewhere and those who have died.
How many children did your mother give birth to, including you?

NUMBER OF BIRTHS TO NATURAL MOTHER ______

902. CHECK 901:

TWO OR MORE BIRTHS __ (GO TO 903)
ONLY ONE BIRTH (RESPONDENT ONLY) __ (GO TO 1001)

903. How many of these births did your mother have before you were born?

NUMBER OF PRECEDING BIRTHS ____

904. What was the name given to your oldest (next oldest) brother or sister?

__________

905. Is (NAME) male or female?

MALE 1
FEMALE 2

906. Is (NAME) still alive?

YES 1
NO 2 (GO TO 908)
DK 8 (GO TO NEXT BROTHER OR SISTER)

907. How old is (NAME)?

__________ (GO TO NEXT BROTHER OR SISTER)

908. In what year did (NAME) die?

19___ (GO TO 910)
DK 98

909. How many years ago did (NAME) die?

__________

910. How old was (NAME) when she/he died?

__________(IF MALE OR DIED BEFORE 12 YEARS OF AGE GO TO NEXT BROTHER OR SISTER)

911. Was (NAME) pregnant when she died?

YES 1 (GO TO 914)
NO 2

912. Did (NAME) die during childbirth?

YES 1 (GO TO 915)
NO 2

913. Did (NAME) die within two months after the end of a pregnancy or childbirth?

YES 1
NO 2 (GO TO 915)

914. Was her death due to complications of pregnancy or childbirth?

YES 1
NO 2

915. How many children did (NAME) give birth to during her lifetime?

__________ (GO TO NEXT BROTHER OR SISTER)

IF NO MORE BROTHERS OR SISTERS, GO TO 1001.

SECTION 10. FEMALE CIRCUMCISION

1001. Are women circumcised in this area?

YES 1
NO 2
DOES NOT KNOW 8

1002. Have you ever been circumcised?

YES 1
NO 2 (GO TO 1006)

1003. What type of circumcision did you have?
Did you have clitoridectomy, excision, or infibulation?

CLITORIDECTOMY 1
EXCISION 2
INFIBULATION 3
OTHER (SPECIFY) _________________ 6

1004. How old were you when you were circumcised?

AGE IN COMPLETED YEARS ____
DOES NOT KNOW 98

1005. Who performed the circumcision?

DOCTOR 1
TRAINED NURSE/MIDWIFE 2
TRADITIONAL MIDWIFE 3
CIRCUMCISION PRACTITIONER 4
OTHER (SPECIFY) ____________ 6
DOES NOT KNOW 8

1006. CHECK 214 AND 216:

HAS AT LEAST ONE LIVING DAUGHTER ___ (GO TO 1007)
HAS NO LIVING DAUGHTER ___ (GO TO 1011)

1007. Has (NAME OF ELDEST LIVING DAUGHTER) been circumcised?

YES 1
NO 2 (GO TO 1011)

1008. How old was she when she was circumcised?

AGE IN COMPLETED YEARS ____
DOES NOT KNOW 98

1009. Who performed the circumcision?

DOCTOR 1
TRAINED NURSE/MIDWIFE 2
TRADITIONAL MIDWIFE 3
CIRCUMCISION PRACTITIONER 4
OTHER (SPECIFY) ____________ 6
DOES NOT KNOW 8

1010. Did anyone object to your eldest daughter being circumcised? Anyone else?
RECORD ALL PERSONS MENTIONED.

RESPONDENT A
RESPONDENT'S HUSBAND B
RESPONDENT'S MOTHER C
RESPONDENT'S MOTHER-IN-LAW D
OTHER RELATIVE OF RESPONDENT E
OTHER RELATIVE OF HUSBAND F
OTHER (SPECIFY) ____________ X

1101. RECORD THE TIME

MORNING/AM 1
AFTERNOON/PM 2
HOUR _______
MINUTES _______

SECTION 11. HEIGHT AND WEIGHT

1101. CHECK 215:

ONE OR MORE BIRTHS SINCE JAN. 1991
IN 1102 (COLUMNS 2 - 4) RECORD THE LINE NUMBER FOR EACH CHILD BORN SINCE JANUARY 1991 AND STILL ALIVE.
IN 1103 AND 1104 RECORD THE NAME AND BIRTH DATE FOR THE RESPONDENT AND FOR ALL LIVING CHILDREN BORN SINCE JANUARY 1991.
IN 1106 AND 1108 RECORD HEIGHT AND WEIGHT OF THE RESPONDENT AND THE LIVING CHILDREN.
(NOTE: ALL RESPONDENTS WITH ONE OR MORE BIRTHS SINCE JANUARY 1991 SHOULD BE WEIGHED AND MEASURED EVEN IF ALL OF THE CHILDREN HAVE DIED. IF THERE ARE MORE THAN 3 LIVING CHILDREN BORN SINCE JANUARY 1991, USE ADDITIONAL FORMS).
NO BIRTHS SINCE JAN. 1991 __ (END)

1102. LINE NO. FROM Q.212

________

1103. NAME FROM Q.212 FOR CHILDREN

(NAME) ______________

1104. DATE OF BIRTH
FROM Q.215 FOR RESPONDENT
FROM Q.215 FOR CHILDREN, AND ASK FOR DAY OF BIRTH

MONTH __
YEAR __

1105. BCG SCAR ON TOP LEFT SHOULDER

SCAR SEEN 1
NO SCAR 2

1106. HEIGHT (in centimeters)

_____._

1107. WAS HEIGHT/LENGTH OF CHILD MEASURED WHILE CHILD WAS LYING DOWN OR STANDING UP?

LYING 1
STANDING 2

1108. WEIGHT (in kilograms)

_____._

1109. DATE WEIGHED AND MEASURED

DAY __
MONTH __
YEAR __

1110. RESULT

MEASURED 1
NOT PRESENT 3
REFUSED 4
OTHER (SPECIFY) ________6

1111. NAME OF MEASURER: ________ __
NAME OF ASSISTANT: _________ __

INTERVIEWER'S OBSERVATIONS

To be filled in after completing interview

Comments about Respondent:
______________________________

Comments on Specific Questions:
_______________________________

Any Other Comments:
_________________________

SUPERVISOR'S OBSERVATIONS
_________________________

Name of Supervisor: ___________________________
Date: _____________

EDITOR'S OBSERVATIONS
_________________________

Name of Editor: _______________________________
Date: _____________